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Most patients did well after arthroscopic rotator cuff repair, yet some tears remain
Investigators identified infraspinatus involvement as a poor prognostic factor a prospective study.
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FLORENCE, Italy — A surgeon who treated rotator cuff tears with an arthroscopic single-row anchor technique reported pain relief and increased range of motion over time with a minimum of 2 years follow-up.
Most of the tears U.S. investigators followed in their prospective functional study were medium-sized (59%) and involved the supraspinatus tendon.
“Pain relief and satisfaction is very predictable with good to excellent improvement in strength,” said Brian J. Cole, MD, of Chicago. He presented results at the 2007 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress, here.
The study involved 49 rotator cuff repairs in 47 patients (28 men, 19 women; 57 years old, average). Seventy-one percent of tears were in the patient’s dominant arm.
Investigators for the single-surgeon study hypothesized that at 2-year follow-up, arthroscopic rotator cuff repair with resorbable anchors would produce decreased pain.
Complex tears
Cole, who performed all the surgeries, used 2.3 anchors (average) and typically placed them laterally.
“A side-to-side repair would be performed for L-shaped, U-shaped and complex tears before lateral placement of the tendon to the bone,” he said.
The investigators followed patients using the American Shoulder and Elbow Score (ASES), Constant score, Visual Analog Scale (VAS), SF-12, simple shoulder test (SST) and a satisfaction survey.
At a minimum follow-up of 2 years, all patients had the integrity of their repair evaluated with MRI.
“All patient-derived scores significantly improved between the preoperative and final follow-up periods (P=.001),” according to the study’s abstract.
22% retear rate
Patients improved based on VAS pain scores.
“There was a statistically significant reduction in pain when we looked at preoperative scores vs. postoperative scores, and this reduction in pain remained very similar, with no differences even at 6 months, 1-year and 2-year follow-up,” Cole said.
Postop ASES scores improved through 6 months but tended to level off at later follow-up. SST results followed a similar pattern; however, the improvements remained “robust” through 2 years, Cole said.
Analyzing the strength and range of motion subsets of the Constant score separately, investigators saw differences between the 1- and 2-year follow-ups in both areas, which were less marked when they analyzed the patients’ composite scores. For example, following patients’ strength scores from preop through 6 months, 1 year and 2 years postop, they could directly attribute differences in strength to better increased forward flexion and external rotation.
The overall failure rate was 22% based on MRI with 11 retears, 73% of which were large or massive. Most retears occurred in older, less active patients; two involved the infraspinatus, Cole said.
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Images: Cole BJ |
For more information:
- Brian J. Cole, MD, MBA, can be reached at the Rush Cartilage Restoration Center, Rush University Medical Center, 1725 W. Harrison St., #1063, Chicago, IL 60612; +1-312-432-2300; e-mail: bcole@rushortho.com. He is a consultant to Arthrex and Genzyme.
Reference:
- Cole BJ, McCarty LP, et al. Arthroscopic rotator cuff repair: Prospective functional outcome and repair integrity at minimum 2-year follow-up. #40. Presented at the 2007 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress. May 27-31, 2007. Florence, Italy.